Stroke - Cerebrovascular event Flashcards
What is a stroke?
Clinical syndrome caused by disruption of blood supply to the brain, characterised by rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24 hours or leading to death
What are the 2 main types of stroke?
- Ischaemic stroke (85%)
- Haemorrhagic stroke (15%)
What is meant by ischaemic stroke?
Ischaemic strokes occur when blood supply in a cerebral vascular territory is reduced due to stenosis or complete occlusion of a cerebral artery
What are the 5 TOAST classified causes of ischaemic stroke?
- Large vessel atherosclerosis (50%) - TOAST1
- Intracranial small vessel atherosclerosis (25%) - TOAST3
- Cardio-embolic (20%) - TOAST2
- Other (5%) - TOAST4
- Unknown - TOAST5
Give an example of a large vessel atherosclerotic cause of stroke
Carotid artery stenosis
What are some cardio-embolic causes of stroke?
- Atrial fibrillation
- Endocarditis
- Valvular heart disease
What re some rarer causes of stroke?
Vasculitis
Non-inflammatory vasculopathy
genetic microangiopathies
Parainfectious
Haematological causes
Other
What are some non-inflammatory vasculopathies that can cause stroke?
- Dissection
- Moya-Moya angiopathy
- Metabolic (Fabry disease, homocystinuria)
- Carotid artery web
What are some genetic microangiopathies?
CADASIL, CARASIL, MELAS (SUSAC syndrome is non-genetic)
What are some parainfectious causes of stroke
Covid
HIV
What are some haematological causes of stroke?
- Primary - Antiphospholipid syndrome
- Secondary - Cancer, TTP, IBD
What are some drugs that can cause stroke?
Contraceptives, cocaine, heroin
What are some pregnancy related causes of stroke?
Eclampsia, pre-eclampsia
What are some other embolic causes of stroke (Not cardio-embolic)
Fat embolism
Air embolism
Tumour embolism
What is haemorrhage stroke?
Haemorrhagic stroke occurs when there is rupture of a cerebrospinal artery, with most being due to a primary haemorrhage or subarachnoid haemorrhage
What are some causes of primary haemorrhage in haemorrhage stroke?
Hypertensive, caused by cerebral amyloid angiopathy or rupture of an aneurysm
What are some causes of young stroke (<50)?
Patent foramen ovale or arterial dissection (Identified by TTE with bubble or transcranial doppler)
What are some risk factors for stroke?
- Hypertension
- High BMI
- High fasting glucose
- Air pollution
- Smoking
- Poor diet
- High LDL cholesterol
- Kidney dysfunction
- Alcohol use
- Sedentary lifestyle
Which brain hemisphere is dominant?
Left
What is a common symptom of dominant (left) hemisphere cortical event?
Language dysfunction
What is a common symptom of non-dominant (Right) hemisphere cortical event?
Spatial awareness dysfunction
What are the 2 regions of affected brain tissue in stroke?
Ischaemic core
Penumbra
What is the ischaemic core?
The area of brain which has developed necrosis (Cerebral blood flow < 20%)
What is the penumbra?
The region of tissue around the area with reduced cerebral blood flow, but is getting a supply of O2 and glucose from collateral arteries
This can progress to infarction, but is still salvageable